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Preoperative period is the time spent by the patient in hospital from the moment when the diagnosis is established

and the decision about surgery is taken till the beginning of surgery.

The tasks of preoperative period

To diagnose the disease, to detect the complications of the basic disease and concomitant diseases. To assess the condition and extent of affection of the patients organs and systems. To determine the indications for surgery, to assess the surgical and anesthesiological risks, to choose the method of intervention and of anesthesia.

The tasks of preoperative period

To inform the patient of the coming surgery and to prepare him psychologically. To take measures to improve impaired functions of the patients organs and systems and to cure, if possible, concomitant diseases. To reduce the risk of endogenous infection.

Surgery can be

Immediate if the patient is not operated immediately upon admission, he can die or develop serious complications (hemorrhage, peritonitis). Urgent it is performed some time after admission which has to do with confirmation of the diagnosis and preparation of the patient. This period is usually 2448-72 hours. Surgery cannot be delayed for longer as the pathological process progresses and the patients state may deteriorate (malignant tumours, pneumothorax, hemotharx without continuous bleeding). scheduled it can be performed at any time without damaging the patients health.

The main signs of cardiovascular and respiratory failure


shortness

of breath, especially upon slight physical exertion and in rest; cyanosis; tachycardia;
edema.

All patients preparing for scheduled surgery should have the following taken:
blood

pressure, pulse and respiratory rate daily; ECG (if normal, only once); Chest X-ray.

Clinical urine analysis gives preliminary information about:


concentration ability of the kidneys (density of urine), disorder of filtration ability (excretion of protein with urine), possibility of inflammatory process (considerable levels of leucocytes and erythrocytes)

Diabetes.
anamnesis and complaints (in most cases the patients report themselves that they have diabetes) blood sugar analysis (N=3.3-5.5 mmole/l). If there is diabetes or blood sugar is high, blood sugar is observed over a day (blood sugar test is done every 3 hours) and an endocrinologist is invited to take part in the preoperative preparation.

In urgent surgery investigations should be done by all means:


taking case history, the patients complaints; physical examination (palpation, percussion, auscultation); heart rate, respiratory rate, blood pressure; ECG for all patients over 40 (young people receive it if they have complaints or cardiovascular diseases in past history); Chest X-ray if there are complaints about respiratory system or in past history; Clinical blood test; Clinical urine test; Blood sugar; Blood grouping, Rhesus-factor.

lassification of surgical risks

Somatically healthy people having scheduled surgery (herniotomy, scraping of uterine cavity, diagnostic procedures). Patients with completely compensated pathology of inner organs having minor surgery. Somatically healthy patients having more serious surgery like cholecystectomy.

lassification of surgical risks

Patients with completely compensated pathology of inner organs having serious extensive surgery (stomach resection, surgery on large intestine, chest surgery). Patients with partially compensated pathology of inner organs having minor or medium surgery. Patients with a combination of profound somatic disorders (acute or chronic ones caused, for example, by myocardial infarction, trauma, shock, massive hemorrhage, peritonitis, sepsis, intoxication) having urgent surgery.

General preparation is given to all patients independently of diagnosis and the type of surgery.

Specialized preparation is given to patients with concomitant diseases or those facing certain types of surgery.

Preparation of respiratory organs.

Smoking should be dropped for at least 2-3 weeks before surgery. If the patient stops smoking on the eve of surgery, the secretion of bronchial tree increases. As the patient has difficulty expectorating the sputum, the infected phlegm is aspirated into deeper parts of bronchial tree which can cause postoperative pneumonia.

Mendelsons syndrome
If the contents of stomach cannot be evacuated for some reason, the surgical risk raises by two points. It is important because during anesthesia muscles relax and gastric contents can flow into the stomatopharynx and then be aspirated into the trachea.

Preparation of skin for surgery

On the eve of surgery all patients should take a bath or shower. For seriously ill patients the area of incision is washed. On the day of surgery the hair is shaved in the area of preoperative skin treatment), the skin is covered with a clean cloth. In the operating unit the skin is prepared by the Filonchikov-Grossich method. The operative field is surrounded with sterile napkins. Before incising the skin is once again wiped with iodine.

When can patients be operated without their consent?

children (the consent is asked of their parents); invalid patients with mental disease (the consent is asked of the guardian); unconscious patients (the decision about operation is made by a consultation of at least 3 doctors).

Premedication usually includes:

1.0 of 0.1% Atropine solution (spasmolytic, reduces salivation) 1.0-2.0 of 1% benadryl solution (desensitizing drug with a hypnotic effect) 1.0 of 2% promedol solution (narcotic analgesic).

Before urgent surgery the extent of preoperative preparation becomes minimal but the following is absolutely necessary:

to obtain the patients consent to surgery to stabilize his condition, if possible (relieve the shock, replenish blood loss and so on) to administer gastric tube (it is not advisable to wash out the stomach before urgent surgery; in impeded passage of food it can be washed out with a small amount of 4% soda solution) to shave the skin.

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